RESUMO
BACKGROUND: Although tracheostomy is a commonly performed procedure, there is a lack of studies in the pediatric intensive care unit (PICU) setting that describe its association with patient outcome and especially hospital mortality. Our goal was to evaluate the outcome of patients receiving a tracheostomy, while on mechanical ventilation (MV), in a PICU. METHODS: Records of 260 children were reviewed retrospectively regarding PICU mortality, PICU length of stay (PICU LOS), duration of MV and a cost indicator (weighted hospital days; WHD). RESULTS: Nineteen patients received tracheostomy (7.3%). The mortality of patients submitted to tracheostomy in the longer term was significantly higher compared to patients who were not (52.6%vs. 27.6%; P = 0.04) despite having a significantly lower severity of illness at admission (Pediatric Risk of Mortality score--PRISM) (10.9 vs. 13.7; P < 0.001). The mortality of patients without tracheostomy, however, was significantly higher within 30 days (24.8%vs. 5.2%, P < 0.001). Tracheostomized patients had significantly higher mean PICU LOS (68 days vs. 8 days; P < 0.001), duration of MV (62 days vs. 4 days; P < 0.001) and higher WHD (171.5 vs. 21.5; P < 0.001). CONCLUSION: Contrary to findings in critically ill adult patients, ventilated children receiving a tracheostomy had less favorable outcomes compared with non-tracheostomized patients. In view of the greater use of resources, further studies are needed to confirm and to identify the subgroups of mechanically ventilated patients who will benefit most from this procedure.
Assuntos
Unidades de Terapia Intensiva Pediátrica , Respiração Artificial , Traqueostomia , Criança , Pré-Escolar , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To test air insufflation as an adjunct to placement of enteral feeding tubes and the effectiveness of using a smaller insufflation volume in pediatric patients. DESIGN AND SETTING: A randomized, controlled study in a pediatric intensive care unit in two tertiary hospitals. PATIENTS: A total of 78 children with indication for transpyloric tube feeding were studied. INTERVENTIONS: An unweighted feeding tube was placed into the stomach through the nares; a 20-ml syringe was used to insufflate 10 ml/kg air into the stomach. The tube was advanced an estimated distance into the pylorus or beyond. The control group received the same procedure except for air insufflation. Resident physicians performed all procedures. Abdominal radiography was performed 3 h later. RESULTS: Of 38 tubes in the study group 33 (86.8%) were successfully placed in a single attempt, compared to 18 of 40 tubes (45%) in the control group. Compared with the technique of using 20 ml/kg air for insufflation, no statistically significant difference was observed. No significant complication was observed. CONCLUSIONS: The gastric insufflation technique required no expensive equipment, minimal training, and consistently allowed transpyloric passage of feeding tubes. The use of 10 ml/kg air may significantly improve the rate of success without increasing risks.
Assuntos
Nutrição Enteral/instrumentação , Insuflação/métodos , Unidades de Terapia Intensiva Pediátrica , Sistemas Automatizados de Assistência Junto ao Leito , Brasil , Criança , Pré-Escolar , Nutrição Enteral/métodos , Feminino , Humanos , Lactente , Insuflação/instrumentação , MasculinoRESUMO
CONTEXT: A high number of hospitalized children do not receive adequate sedation due to inadequate evaluation and use of such agents. With the increase in knowledge of sedation and analgesia in recent years, concern has also risen, such that it is now not acceptable that incorrect evaluations of the state of children's pain and anxiety are made. OBJECTIVE: A comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation. DESIGN: Prospective cohort study. SETTING: A pediatric intensive care unit with three beds at an urban teaching hospital. PATIENTS: Thirty simultaneous and independent observations were conducted by specialists on 18 patients studied. DIAGNOSTIC TEST: Comfort and Hartwig scales were applied, after 3 minutes of observation. MAIN MEASUREMENTS: Agreement rate (kappa). RESULTS: On the Comfort scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 20.28 (SD 2.78), 27.5 (SD 0.70), and 15.1 (SD 1.10), respectively, whereas on the Hartwig scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 16.35 (SD 0.77), 20.85 (SD 1.57), and 13.0 (SD 0.89), respectively. The observed agreement rate was 63 per cent (p = 0.006) and the expected agreement rate was 44 per cent with a Kappa coefficient of 0.345238 (z = 2.49). CONCLUSIONS: In our study there was no statistically significant difference whether the more complex Comfort scale was applied (8 physiological and behavioral parameters) or the less complex Hartwig scale (5 behavioral parameters) was applied to assess the sedation of mechanically ventilated pediatric patients.